Peer Support Workers Research Articles

Weaving a new blanket together: lessons on compassionate leadership and engagement from a virtual regional summit on early childhood wellness in northern communities of British Columbia, Canada

BackgroundEarly childhood is a critical period of development for infants, young children, and their families. An array of services, programs, and interventions exist to support families during this life stage, often delivered by a diverse range of professionals. Overlap in early years services exists between healthcare, social care, childcare, education, and not-for-profit organizations. Such diversity in services has the potential to add a rich experience to early childhood development, or without collaboration, widen service gaps, risking providers’ ability to meet the needs of families.MethodsIn northern British Columbia (BC), Canada, a group of individuals came together to approach building relationships and engagement across sectors in early years services using compassionate systems leadership (CSL). A virtual summit was hosted with early childhood service providers including peer support workers and parents/caregivers using a hybrid model of pre-recorded asynchronous sessions combined with a live workshop. The purpose of the event was to find common ground, celebrate local success, and build understanding of how to work collaboratively across the region to identify and address early years priorities.ResultsThe event was successful in engaging 121 providers across early years services from a broad geographic region. Applying CSL principles for engagement allowed the team to examine how all partners could address silos in early years services across northern BC. Using a reflexive thematic approach, four key themes were identified at the Summit: (1) early years services are a patchwork but there are dreams of weaving a new blanket together, (2) an ideal model of service is family-centred and inclusive, (3) all sectors are needed at the table, and (4) compassion is the thread that weaves this work together.ConclusionsThe application of CSL principles can be used to guide engagement and develop supportive spaces for open conversation about creating systems change. In facilitating a space that allowed for vulnerability and relational ways of engaging across sectors we discovered commitment and a willingness for those present to consider new ideas and partnerships that would allow for greater integration of early years services in northern BC.

The impact of peer support work on the mental health of peer support specialists

BackgroundPeers support specialists have positive impacts on the mental health of their service users. However, less is known about how their mental health changes as a result of their activities.MethodsWe followed 10 peer support specialists over their first year of employment and interviewed them thrice. We used grounded theory to analyse the way in which the health of participants changed.ResultsSelf-reported mental health of our participants did not change over the course of the study. However, the role did help participants grow and learn about their condition and their strengths. While sharing their past experiences could be taxing, they learned how to harness their recovery journey without risking relapse.ConclusionEntering the role of a peer support specialist does not appear to negatively impact mental health, but might enhance insight and resilience. However, this appears to occur in individuals who already possess an inclination toward introspection.

Managing Peer Support Workers in Swedish Mental Health Services—A Leadership Perspective on Implementation and Sustainability

Even though it has been demonstrated that peer support contributes to positive outcomes for service users, organizational implementation issues remain. The aim of the current study was to examine an implementation of peer support from the perspective of managers in order to develop knowledge of factors influencing sustainability of this initiative. Eighteen managers were interviewed in connection with the introduction of peer support in sixteen mental health settings. Interviews were analyzed utilizing inductive and deductive approaches. The results suggested that managers were predominantly positive in their evaluation of peer support as a recovery-oriented addition to their services, but noted developmental issues regarding role, professional identity, supervision and financing in relation to other traditional personnel. The involvement of the user movement, especially with regard to training and supervision helped prepare staff and support peer workers, yet there was some apprehension attached to the critical scrutiny that this `outsider’ perspective might imply. The results confirm previously noted uncertainties regarding peer support as an integrated component of mental health systems and illuminate a number of culturally conditioned challenges that may hamper peer support from being implemented with the same approach as other interventions. In response, the present study suggests a number of focus areas that should be attended to in future implementation efforts, including issues related to staff roles, power dynamics, connection to the user movement and reconsideration of the value of experience-based knowledge. In the Swedish context, a government level commitment was identified as critical to ensure stable funding.

The impacts of implementing recovery innovations: a conceptual framework grounded in qualitative research

BackgroundImplementing mental health recovery into services is a policy priority in Canada and globally. To that end, a 5 year study was undertaken with seven organisations providing mental health and housing services to people living with a mental health challenge to implement guidelines for the transformation of services and systems towards a recovery-orientation. Multi-stakeholder implementation teams were established and a facilitated process guided teams to choosing and planning for the implementation of one recovery innovation. The recovery innovations chosen were hiring peer support workers, Wellness Recovery Action Planning (WRAP), a family support group, and staff recovery training.MethodsThis study reports on data collected at the post-implementation stage. 90 service users, service providers, family members, managers, other actors and knowledge users participated in 41 group, individual or dyad semi-structured interviews. The interview guides included open-ended questions eliciting participants’ impressions regarding the impact of implementing the innovation on service users, service providers and organisations. We applied a collaborative qualitative content analysis approach in NVivo12 to coding and interpreting the data generated from these questions.ResultsEighteen impacts of implementing recovery innovations from the perspectives of diverse stakeholder groups were identified. Three impacts of working as an implementation team member and as part of a research project were also identified. Impacts were developed into a conceptual framework organised around four overall categories of impact: Ways of being, Ways of interacting, Ways of thinking, and Ways of operating and doing business.ConclusionsThe IMpacts of Recovery Innovations (IMRI) framework version 1 can assist researchers, evaluators and decision-makers identify, explore and understand impact in the context of recovery innovations. The framework helps fill a gap in conceptualising service and organisation-level impacts. Future research is needed to validate the framework and map it to existing methods for studying impact.

Shared Decision Making and Peer Support: New Directions for Research and Practice.

Shared Decision Making and Peer Support: New Directions for Research and Practice.

Peer-Facilitated Decision Making in Mental Health: Promises, Pitfalls, and Recommendations for Research and Practice.

Recognition has grown that peer support workers serve an important role in facilitating decision making about treatment and recovery among people with mental health conditions. This article provides examples of peer-facilitated decision support interventions in the literature, discusses promises and potential pitfalls associated with peers serving in decision support roles, and offers recommendations for research and practice. Examples were selected from the literature on decision support interventions for people with serious mental illnesses, such as schizophrenia, bipolar disorder, and major depression. Promises, pitfalls, and recommendations were informed by this research and by the literature on lived experience perspectives, the helper-therapy principle, and reported barriers to and facilitators of peers assisting with decision making. According to the included studies, peers may facilitate decision making in several ways (e.g., by asking service users about their goals or preferences, assisting them with using decision support tools, sharing stories, and facilitating access to information and resources). Peer-facilitated decision support may be associated with positive decision making and health outcomes for service users and peer support workers. However, providers need to carefully consider barriers to implementation of this support, such as inadequate resourcing, poor integration, and compromising of peer support values.

Common Humanity as an Under-acknowledged Mechanism for Mental Health Peer Support

Mental health peer support (PS) is a relational approach to recovery. Service users are helped through a relationship focused on connection with a PS worker who shares similar experiences. Despite the strong evidence base, the mechanisms of action for mental health PS are under-researched. Several theories have been proposed to explain the mechanisms, including social comparison theory (SCT). SCT highlights the benefits arising from emphasising differences between a service user and the PS worker. An unintended consequence is that connection between them may be reduced. We propose common humanity (CH) as an under-acknowledged mechanism of action. CH is an experience recognising that there are other people living with similar suffering, and helps us regulate emotions. A CH-informed connection-based PS relationship may help a service user in different ways from a SCT-informed comparison-based PS relationship. Future PS research can investigate emotional self-regulation to establish whether CH-related outcomes arise from PS.

Mental health workers’ perspectives on peer support in high-, middle- and low income settings: a focus group study

BackgroundPeer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers’ attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings.MethodsSix focus groups were conducted in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be’er Sheva (Israel), and Ahmedabad, Gujarat (India) with a total of 35 participants. Transcripts were analyzed using thematic content analysis.ResultsParticipants across the study sites demonstrated overall positive attitudes towards peer support in mental health care, although some concerns were raised on potentially harmful effects of peer support such as negative role modelling and giving inadequate advice to service users. Notably, mental health workers from low- and middle-income countries described peer support workers as bridge-builders and emphasized the mutual benefits of peer support. Mental health workers’ views on peer support workers’ roles and role boundaries differed between sites. In some settings, mental health workers strongly agreed on the need for role clarity, whereas in others, mental health workers expressed mixed views, with some preferring blurred role boundaries. Regarding collaboration, mental health workers described peer support workers as supporters and utilizers, equal partners or emphasized a need for trust and commitment.ConclusionsMental health workers’ attitudes toward peer support workers were positive overall, but they also varied depending on local context, resources and previous experiences with peer support. This affected their conceptions of peer support workers’ roles, role clarity, and collaboration. This study demonstrated that reconciling the need for local adaptations and safeguarding the core values of peer support is necessary and possible, especially when the implementation of recovery-oriented interventions such as peer support is accelerating worldwide.

Social service providers’ perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study

BackgroundPeople who use drugs and are structurally vulnerable (e.g., experiencing unstable and/or lack of housing) frequently access acute care. However, acute care systems and providers may not be able to effectively address social needs during hospitalization. Our objectives were to: 1) explore social service providers’ perspectives on addressing social needs for this patient population; and 2) identify what possible strategies social service providers suggest for improving patient care.MethodsWe completed 18 semi-structured interviews with social service providers (e.g., social workers, transition coordinators, peer support workers) at a large, urban acute care hospital in Western Canada between August 8, 2018 and January 24, 2019. Interviews explored staff experiences providing social services to structurally vulnerable patients who use drugs, as well as continuity between hospital and community social services. We conducted latent content analysis and organized our findings in relation to the socioecological model.ResultsTensions emerged on how participants viewed patient-level barriers to addressing social needs. Some providers blamed poor outcomes on perceived patient deficits, while others emphasized structural factors that impede patients’ ability to secure social services. Within the hospital, some participants felt that acute care was not an appropriate location to address social needs, but most felt that hospitalization affords a unique opportunity to build relationships with structurally vulnerable patients. Participants described how a lack of housing and financial supports for people who use drugs in the community limited successful social service provision in acute care. They identified potential policy solutions, such as establishing housing supports that concurrently address medical, income, and substance use needs.ConclusionsBroad policy changes are required to improve care for structurally vulnerable patients who use drugs, including: 1) ending acute care’s ambivalence towards social services; 2) addressing multi-level gaps in housing and financial support; 3) implementing hospital-based Housing First teams; and, 4) offering sub-acute care with integrated substance use management.

Comparative Effectiveness of Integrated Peer Support and Clinical Staffing Models for Community-Based Residential Mental Health Rehabilitation: A Prospective Observational Study

This observational study compared the outcomes of consumers receiving community-based residential mental health rehabilitation support in Australia under a clinical staffing model and an integrated staffing model where Peer Support Workers are the majority component of the staffing profile. Reliable and clinically significant (RCS) change between admission and discharge in functional and clinical assessment measures were compared for consumers receiving care under the clinical (n = 52) and integrated (n = 93) staffing models. Covariate analyses examined the impact of known confounders on the outcomes of the staffing model groups. No statistically significant differences in RCS improvement were identified between the staffing models. However, logistic regression modelling showed that consumers admitted under the integrated staffing model were more likely to experience reliable improvement in general psychiatric symptoms and social functioning. The findings support the clinical and integrated staffing models achieving at least equivalent outcomes for community-based residential rehabilitation services consumers.

Co-produced Positive Psychotherapy for Acute Psychiatric Ward Patients and Staff: an Evaluation of Feasibility and Acceptability

Aim: To investigate feasibility and acceptability of positive psychotherapy for acute psychiatric ward patients and staff, when delivered by non-psychology clinical staff, and co-produced with staff with lived experience. Method: Group or individual strengths-based positive psychotherapy was led by an activity coordinator and co-facilitated by a peer support worker with lived experience of mental health problems. It was delivered for acute ward patients and staff. Feasibility was measured by completion of session components and percentage of participants able to identify a strength, plan a strength-based activity, and activity completion. Acceptability was measured by comparing pre- and post-session mood, and with helpfulness ratings and narrative feedback. Results: Participants (n = 22) included 12 patients and 10 staff members. Participants were mainly female and of white or mixed ethnicity. Most patients had a psychotic disorder. Staff were nurses and healthcare assistants. The most identified strengths were self-regulation, social intelligence and perseverance. Typical activities included activity-scheduling, sleep hygiene, walking, gardening and cooking. High completion rates for components and activities indicated feasibility. Lack of adverse effect on mood, high helpfulness ratings, and positive feedback indicated acceptability. Conclusion: This evaluation indicates that non-psychology staff can deliver psychological interventions, that interventions can be co-produced with staff with lived experience, and that patient and staff participants can collaborate on these interventions. This shows how psychological interventions on acute wards can be inclusive, positively impact on ward culture, and be more widely delivered to support patients and staff.

Experiences of peer support workers supporting individuals with substance use disorders in Egypt: phenomenological analysis

BackgroundPeer support work for substance use disorders is widely implemented in high-income countries. More research is still needed to understand its applicability in settings which have proportionately low budgets allocated to mental health. Peer Support Workers are individuals who managed to achieve recovery from substance use disorders and help people remain engaged in their recovery and prevent relapse through shared understanding.AimTo investigate the experience of peer support workers providing recovery support to people with substance use disorders in Egypt.MethodsA qualitative phenomenological design was used in which 17 adults working as peer support workers for substance use disorders were recruited by means of purposive and snowball sampling. A semi-structured interview with participants was conducted by phone or video-call. Interviews were transcribed and thematically analysed based on descriptive phenomenology.ResultsThree superordinate themes were identified: role responsibility, Peer Support Workers’ need for organizational and stakeholders’ support, and challenges to the role integrity.Conclusion and recommendationsThe findings indicate the need for national and governmental support to peer support workers engaged with people with substance use disorders in Egypt and educating families and the public about the role of peer support workers in substance use disorders.

Program seeks to grow workforce of peers for youths, families

A youth‐ and family‐focused center housed at the University of North Carolina Greensboro (UNCG) has announced the launch of a program to enhance peer support services targeting youths with mental health needs and their families. Details of the new initiative remain sketchy at this early stage, but a coordinator with the university's Center for Youth, Family and Community Partnerships told MHW that the program will strive to make trained peer support workers available to youth and families in all 100 North Carolina counties.

Peer Support at the Intersection of Disability and Opioid (Mis)Use: Key Stakeholders Provide Essential Considerations.

Individuals with disabilities may experience higher rates of opioid/substance use disorders (OUD/SUD) than other individuals and are likely vulnerable to unmet treatment needs. Peer support may be beneficial to these individuals, given the evidence of benefits in target populations with similar needs and the potential for overcoming barriers to treatment suggested in the available literature. The objective of this exploratory study was to specify essential considerations in adapting peer support for this population. Diverse key stakeholders (n = 16) were interviewed to explore the experiences, needs, and available supports for individuals with disabilities and OUD/SUD. A Peer Support Work Group including members with lived experience advised each component of the study. Semi-structured interview data were content analyzed and memos generated to summarize themes related to the research question. Participants reported extensive professional and personal experience in human services, disability, and recovery. Emergent themes included the importance of accessibility and model fit, the notion of “peerness” and peer match, and essential aspects of peer recruitment, training, and support. An accessible, acceptable, effective model of peer support requires particular attention to the needs of this diverse and varied population, and the contexts in which they are identified, referred, and engaged in services.

Staff experiences of working alongside peer support workers in forensic mental health community teams: a qualitative study

PurposePeer support workers (PSWs) are individuals with lived experience of mental health difficulties, who apply this to support and inspire others in their recovery. The role of PSWs is relatively new within the forensic health-care service. Although there has been little time for these roles to develop, PSWs have successfully integrated into community teams. Despite perceived benefits of having these workers within a multi-disciplinary team (MDT), the views held by mental health professionals in forensic services have not yet been studied. The purpose of this research is to develop an understanding of the experiences of staff working with PSWs in a community forensic team and the impact this has on them.Design/methodology/approachStructured, individual interviews were conducted with eight mental health professionals, from a variety of disciplines, used across two community teams within forensic services. The data was examined according to thematic analysis.FindingsThe data indicated general positive attitudes held by professionals surrounding the working with PSWs, including the themes “providing alternative perspectives”, “unique relationships” and “hope”. Yet, themes concerned around “role ambiguity”, “boundaries” and “the impact on PSWs” also arose.Practical implicationsThis study provides insight into the attitudes held by members of an MDT of working with PSWs. Although seemingly positive, the lack of clarity around the role of the PSW is problematic.Originality/valueTo the best of the authors’ knowledge, this is the first study to explore the employment of PSWs in the context of UK forensic settings, highlighting the benefits and challenges of such from the perspective of staff.

Peer Support Workers as Equal Team Members. A Case Study of Peer Support in Glasgow Housing First

Abstract The text investigates peer support in the Glasgow Housing First project. Housing First is considered a social innovation towards ending chronic homelessness. Peer support should be an integral part of this approach, but little is known about its role. The aim of this text is to analyse peer support in the project from the perspective of its team and service users. We carried out an instrumental case study. For data collection we used semi-structured and group interview, direct observation, and studied service users’ files. To analyse the data, we conducted thematic analysis. We found out that peer support workers are seen as equal team members. Peer support needs to be recognised in the organisation, job role defined, and an adequate salary secured. We also present challenges in the areas of personal boundaries, self-care, and fulfilment of formal job requirements, and therefore it is crucial to provide peer mentor’s position within the team. Peer support relates to the provision of healing relationship with hard engagers and service users’ led support. Together with using specific tools and community resources, peer support results in either graduation from Housing First, sustaining their tenancy as Housing First tenants, or less days in homelessness.

Qualitative Study to Support Future Implementation of Peer Support in a Psychiatric Emergency Room Service in Campinas, Brazil

Abstract
 
 Objective: This article describes the findings from a qualitative study conducted in a psychiatric emergency room at the Hospital of the State University of Campinas (Unicamp). Two focus groups collect data from people with serious mental illness (SMI) and professionals from hospital-based psychiatric services (HBPS) to explore challenges and opportunities for future implementation of peer support on Unicamp psychiatric emergency room service in Campinas Brazil. Research Design: The study was conducted in Campinas, Brazil, in January 2020. Volunteers formed two focus groups (n = 10) and discussed relevant questions to implement a peer-based model on the ER psychiatric unit. Methods: Thematic Analysis was used for this study. The sessions were recorded and later transcribed, and data were analyzed and organized in Themes. Results: The research team grouped four themes from the client's perceptions of challenges: lack of access to mental health services, lack of care, treatment voiceless, self-perception about stigma. The client's perceptions of opportunities generate two themes: trust and relationships and appraisal of emotional network and support. The professional's perceptions developed four themes of challenges described as sustainability and adherence to treatment, living with serious mental illness, ER professional roles and limits, and implementation of peer support in the ER. The professional's perceptions of opportunities generated two themes: understanding peer support roles and the positive impact of peer support in the ER. Conclusions: The qualitative data highlights the need for peer support working in the ER psychiatric unit. Also suggested the relevance of large-scale research to build strategies to future implement peer support on the ER psychiatric unit.
 Keywords: 
 Qualitative research, peer support, people with serious mental illness, mental health workers.

Successful Implementation of Peer Support for People with Severe Mental Illness in Germany: a Theory of Change Approach

Peer support is an established intervention in which people with mental illness receive support by trained peer support workers who have already overcome a mental health crisis. The implementation of peer support is complex due to interacting factors and can be achieved through the participatory Theory of Change method. Aim of this study is to develop a cross-site Theory of Change for the sustainable implementation of UPSIDES peer support in Germany. Based on site-specific Theories of Change workshops from Ulm and Hamburg in which 47 participants took part, a cross-site Theory of Change was designed and verified in three follow-up workshops with 12 participants. Participants' professional and experiential backgrounds were diverse, including peer support workers, hospital directors and managers, mental health professionals (psychiatrists, psychotherapists, nurses), and researchers. The first pathway of the cross-site Theory of Change focuses on the training of peer support workers, whereas the second pathway emphasizes recognition and integration by mental health institutions and professionals. The third pathway specifies the building of a cross-professional care network to integrate various peer support services. Procedures to approach prospective peer clients are depicted in the fourth pathway. The fifth path addresses the clarification of the role description of peer support workers and the implementation in other institutions through cooperation. Many of the identified implementation steps have been validated in comparable studies. The development of this Theory of Change by bringing together multiple perspectives of key stakeholders is an important basis for the sustainable implementation of UPSIDES peer support. Furthermore, it may serve as a blueprint for the implementation of similar interventions to advance scaling-up of evidence-based user-led and recovery-oriented interventions. The Theory of Change approach is a well-accepted and feasible method, which can be recommended for the implementation of complex interventions such as UPSIDES peer support.

Leadership enhancing culturally safe models of care in a Western Australian Aboriginal community context: A qualitative investigation

BackgroundModels of care for community health nursing need to address social determinants of health for families, requiring community health nurse leaders to encourage all nurses to facilitate culturally safe models of care, particularly for vulnerable and underserved populations. Many challenges impact on provision of support for a range of population groups, with increasing attention focusing on how community health nurses lead equitable health activities for Aboriginal Australian families. AimThe aims of this study were to investigate the suitability, feasibility and acceptability of parent support, informing a culturally safe model for a peer-led support program for Aboriginal families. MethodsParticipatory action research enabled Aboriginal peer support workers and parents, community agencies and a child health researcher to collaboratively review cultural safety, suitability, and progress of the program. Qualitative data were analysed through thematic analysis. FindingsThe Australian Health Practitioner Regulatory Agency's cultural safety framework guided four themes: Acknowledgement of colonisation, racism, and social determinants of health; recognition of influences of personal racism and power differentials; recognising importance of partnership approaches to care and collaboration with individuals and families to ensure appropriate and acceptable care; and promotion of safe working environments. DiscussionCommunity-based initiatives informed by Aboriginal perspectives are needed to support Aboriginal families. Participatory action research enables community health nurse leaders to engage with Aboriginal participants, facilitating co-design of culturally safe models of care. ConclusionReflections on culturally safe strategies enabled development of peer-led support for Aboriginal families, focusing on self-determination, empowerment, and equity. Acceptability of the strategies has contributed to an emerging culturally safe model of care. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal.

Peer Interventions in Severe Mental Illnesses: A Systematic Review and its Relation to Occupational Therapy

Peer support is one of the pillars of the recovery model in mental health care. The purpose is to specify the interventions performed by peer support workers (PSWs) and identify the outcomes in terms of the occupational therapy (OT) process with statistical incidence. A systematic review of the peer-to-peer technique in OT was carried out using the PRISMA guidelines and searching scientific databases. The results were ordered according to the Occupational Therapy Practice Framework-4, finding significant positive results in 7 of the 10 outcome categories. PSWs can be essential partners in achieving the goals of the OT program.